In endoscopic surgery, detecting structures earlier and differentiating them better is a necessity. The imaging technology has to replace the missing view of the open site. Alongside an optimal image, it is helpful to receive additional information that increases the precision of the surgical technique. This information is supplied, for instance, by NIR/ICG fluorescence imaging – an OPAL1® technology from KARL STORZ.
The use of indocyanine green (ICG) together with light at wavelengths in the near infrared range (NIR) permits visualizing anatomic structures, for instance. KARL STORZ considers fluorescence technology a future standard imaging technique.
IMAGE1 S™ RUBINA – mORe to discover
The new IMAGE1 S™ RUBINA imaging technology from KARL STORZ combines 3D and 4K technology with NIR/ICG fluorescence imaging to support surgeons’ work by supplying high quality information.
NIR/ICG Visualization Modes
The Rubina components offer users various new modes for visualizing the NIR/ICG signal. This includes the overlay of NIR/ICG data onto the standard white light image or alternatively the monochromatic visualization of the infrared signal alone.
In Overlay mode, the regular white light image is combined with the NIR/ICG data to generate an overlay image.
Green or blue – it's up to you
Depending on your preferences and application, the NIR/ICG data can be displayed as a green or blue overlay.
Displays the intensity of the NIR/ICG signal using a color scale in an overlay image.
In this mode, the NIR/ICG signal alone is displayed in white on a black background to achieve the greatest possible differentiation.
Thanks to modular architecture, new 4K, 3D, NIR/ICG, and LED components can be added to the existing IMAGE1 S™ camera platform. The IMAGE1 S™ RUBINA components offer users new options and a series of advantages to support them in their daily routine.
There is mORe to discover
Example Applications of NIR/ICG
Visualization of Perfusion
Perfusion assessment is important in various medical disciplines. With IMAGE1 S™ RUBINA and ICG administration, ischemic areas, perfusion, and vascular structures can be displayed in real time, thereby enabling the surgeon to respond intraoperatively.
- Rapid perfusion assessment of a planned resection zone as well as of the subsequent anastomosis, e.g., in colon1 or esophageal resection and gastric bypass2
- Display of the cystic artery in cholangiography2
- Visualization of liver segments3 and lung segments4
- Visualization of vessels within and outside of tumor tissue for the improved definition of tumor margins in otorhinolaryngology5
- Multidisciplinary use in laparoscopic, endoscopic, and open surgery
1Koh et al., Fluorescent Angiography Used to Evaluate the Perfusion Status of Anastomosis in Laparoscopic Anterior Resection, 2016
2Boni et al., Clinical Applications of Indocyanine Green (ICG) Enhanced Fluorescence in Laparoscopic Surgery, 2015
3Diana M et al Superselective Intra-arterial Hepatic Injection of Indocyanine Green (ICG) for Fluorescence Image-guided Segmental Positive Staining: Experimental Proof of the Concept, 2017
Due to its hepatobiliary excretion, ICG collects in the gallbladder and bile ducts. This allows, for instance, the rapid and easy identification of the biliary anatomy in cholecystectomy.
- Reduced surgical duration with ICG when compared to standard cholangiographies.1 Facilitated differentiation between cystic duct and common bile duct.2
- Visual perceptual illusion is the cause of 97% of bile duct injuries; moreover, 19% of all patients exhibit abnormal anatomic variations of the gallbladder.3
- Display of intraoperative bile leakage with ICG, e.g., following partial hepatectomy.
1Dip et al., Cost analysis and effectiveness comparing the routine use of intraoperative fluorescent cholangiography with fluoroscopic cholangiogram in patients undergoing laparoscopic cholecystectomy, 2014
2Boni et al., NIR/ICG Fluorescence Imaging in Laparoscopic Surgery, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-933-1)
3Dip F., et al., EndoPress Silverbrochure, Fluorescence Cholangiography, 2017
Visualization of Hepatocellular Carcinoma and Metastases
Primary liver tumors are the sixth most common type of cancer worldwide. Metastases to the liver are even more common than primary liver tumors, by a factor of 20.1 IMAGE1 S™ RUBINA in combination with ICG offers many advantages in liver surgery.
- Intraoperative visualization of metastases and hepatocellular carcinoma on or below the liver surface2
- Diagnostics of superficial or near-surface micrometastases down to the millimeter range3
- Easier definition of resection borders4
- Visualization of liver segments
1Cancer in Germany 2011/2012 (10th edition), Robert Koch Institute, Berlin
2Visualization of ICG up to a depth of one centimeter, depending on the tissue composition
3Tummers et al., First experience on laparoscopic near-infrared fluorescence imaging of hepatic uveal melanoma metastases using indocyanine green, 2014
4Boni et al., ICG-Enhanced Fluorescence-Guided Laparoscopic Surgery, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-934-8)
Visualization of the Lymphatic System
The reliable identification of the lymphatic system or the sentinel lymph node represents a challenge in oncological procedures. The use of ICG* in these procedures permits the real-time visualization of the entire lymphatic system draining the tumor. Nuclear medicine imaging can therefore be avoided.1
- Non-radioactive method for lymph node visualization
- Detection rates compare favorably with established methods of lymph node visualization2
- Localization of lymphatic leakages3
- Multidisciplinary use, for instance in gynecology, urology, and general surgery
*The approval status of the drug may vary. Before using it, please determine the status applicable at your hospital or in your country.
1Papadia A. et al., ICG-Enhanced Fluorescence-Guided SLN Mapping in Gynecological Malignancies, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-932-4)
2Imboden et al., A Comparison of Radiocolloid and Indocyanine Green Fluorescence Imaging, Sentinel Lymph Node Mapping in Patients with Cervical Cancer Undergoing Laparoscopic Surgery, 2015
3Papadia A et al. Indocyanine Green Fluorescence Imaging in the Surgical Management of an Iatrogenic Lymphatic Fistula: Description of a Surgical Technique, 2015